Manage APCD compliance programs and reporting requirements across multiple states
Lead projects from start to finish, including timelines, regulator communications, and extension requests
Interpret state regulations and convert them into business and system requirements
Oversee timely submission of reports, files, and responses to regulators and vendors
Investigate compliance, reporting, and system issues; identify root causes and support corrective actions
Write detailed business requirements to address compliance and data issues
Use reporting tools, databases, and data analysis to monitor compliance and improve processes
Identify opportunities to automate and streamline workflows
Train, mentor, and coach team members and business partners
Develop and maintain training materials, policies, procedures, and process documentation
Build relationships across departments to improve collaboration and results
Communicate effectively with regulators, vendors, clients, account managers, IT teams, and leadership
Escalate risks, issues, and compliance concerns when appropriate
Create management reports and provide recommendations for issue resolution

5+ years of compliance or legal experience in healthcare, insurance, or financial services
5+ years of experience with healthcare products, including: HMO PPO Medicare Advantage Medicare Part D
2+ years of pharmacy-related experience, including: Specialty drugs Medicare Part D PBM (Pharmacy Benefit Manager) operations
Understanding of healthcare claims processing and industry coding structures
Ability to travel up to 10%

Compliance Manager

Key skills